ILWU Members Receive Coverage for Compounded Medications Only at Accredited Pharmacies

This is to advise you that effective August 22, 2016, the compounding drug portion of the Prescription Drug Program under the ILWU-PMA Coastwise Indemnity Plan (CIP) will only cover compounded drugs that, in addition to other Plan terms are dispensed by an OptumRx Compound Credentialed Pharmacy.

In addition, the compounding drug portion of the Prescription Drug Program will no longer include bulk chemicals on the OptumRx list of excluded bulk chemicals (see attached OptumRx Compound Medication Exclusions list).

Compound prescriptions that cost more than $1,000 will continue to require prior authorization.

Bulk chemicals are sometimes used by pharmacies to make compound prescriptions. Many bulk chemical products are not FDA-approved or are available in alternate forms. Other bulk chemicals have FDA-approved formulations thereby minimizing the need for compounding these ingredients.

Effective August 22, 2016, participants will have to pay out-of-pocket for prescription compound drugs that contain non-covered bulk chemicals or that are filled by a compound pharmacy that is not credentialed by OptumRx.

Compound drugs require a prescription from a doctor and are prepared by a pharmacist who mixes or adjusts drug ingredients to customize a medication to meet a patient’s individual needs. Due to concerns about member safety and drug effectiveness the requirements listed above are being implemented.

If your compound pharmacy is not on the current Credentialed Pharmacies Listing attached, your compound prescription will not be covered. Please talk to your physician and transfer your prescription to a credentialed pharmacy on the attached Credentialed Pharmacies Listing. You may not see a pharmacy near you (or even in your state of residence) listed, however the credentialed pharmacies listed are licensed to dispense and ship compound medications to you.